B超引导下经皮穿刺置管引流术在肝胆外科危急症中的临床应用价值分析
|
摘要
目的探讨B超引导下经皮穿刺置管引流术在肝胆外科危急症中的临床应用价值。方法选取2016年3月～2018年5月于我院住院治疗的相关急性梗阻性化脓性胆管炎患者,根据治疗方式的不同分为常规治疗组及超声引导下穿刺组,观察组给予超声引导下穿刺置管,对照给予常规治疗,观察两组患者的治疗效果。结果治疗后的穿刺置管组患者的WBC恢复正常时间及住院时间均明显低于常规治疗组(P <0.05);穿刺置管治疗前,穿刺置管组和常规治疗组的血清ALT、AST、ALB、TBIL、DBIL水平,差异无统计学意义(P> 0.05);穿刺置管治疗后1周,穿刺置管组患者的血清ALT、AST、ALB、TBIL、DBIL水平均显著低于常规治疗组(P <0.05);穿刺置管组的手术并发症率6.5%明显低于常规治疗组的22.06%,差异有统计学意义(P <0.05)。结论 B超引导下经皮穿刺置管引流术能够显著缩短患者的住院时间,改善患者的肝功能,并能够降低并发症的发生率。
Objective To discuss the clinical application value of b-ultrasound-guided percutaneous catheter drainage in hepatobiliary surgery. Methods Patients with related acute obstructive suppurative cholangitis who were hospitalized in our hospital from March 2016 to May 2018 were selected and divided into conventional treatment group and ultrasound-guided puncture group according to different treatment methods.The observation group received ultrasound-guided catheterization,while the control group received conventional treatment.The therapeutic effects of the two groups were observed. Results The WBC recovery time and hospitalization time of patients in the puncture catheterization group after treatment were significantly lower than those in the conventional treatment group(P<0.05).Serum ALT,AST,ALB,TBIL and DBIL levels of the puncture catheterization group and the conventional treatment group were not significantly different before the puncture catheterization treatment(P > 0.05).One week after the puncture and catheterization treatment,the ALT,AST,ALB,TBIL and DBIL levels of the patients in the puncture and catheterization group were significantly lower than those in the conventional treatment group(P < 0.05).The surgical complication rate of the puncture and catheterization group was 6.5%,which was significantly lower than that of the conventional treatment group(22.06%),and the difference was statistically significant(P < 0.05). Conclusion B-ultrasound-guided percutaneous catheterization and drainage can significantly shorten the length of hospital stay,improve the patient's liver function,and reduce the incidence of complications.
Objective To discuss the clinical application value of b-ultrasound-guided percutaneous catheter drainage in hepatobiliary surgery. Methods Patients with related acute obstructive suppurative cholangitis who were hospitalized in our hospital from March 2016 to May 2018 were selected and divided into conventional treatment group and ultrasound-guided puncture group according to different treatment methods.The observation group received ultrasound-guided catheterization,while the control group received conventional treatment.The therapeutic effects of the two groups were observed. Results The WBC recovery time and hospitalization time of patients in the puncture catheterization group after treatment were significantly lower than those in the conventional treatment group(P<0.05).Serum ALT,AST,ALB,TBIL and DBIL levels of the puncture catheterization group and the conventional treatment group were not significantly different before the puncture catheterization treatment(P > 0.05).One week after the puncture and catheterization treatment,the ALT,AST,ALB,TBIL and DBIL levels of the patients in the puncture and catheterization group were significantly lower than those in the conventional treatment group(P < 0.05).The surgical complication rate of the puncture and catheterization group was 6.5%,which was significantly lower than that of the conventional treatment group(22.06%),and the difference was statistically significant(P < 0.05). Conclusion B-ultrasound-guided percutaneous catheterization and drainage can significantly shorten the length of hospital stay,improve the patient's liver function,and reduce the incidence of complications.
引文
[1]程黎娜,丁辉,杨惠,等.老年晚期恶性梗阻性黄疸3种姑息治疗方法的疗效比较[J].中国内镜杂志,2015,21(11):1148-1151.
[2]Cao X,Cao F,Li A,et al.Predictive factors of pancreatic necrosectomy following percutaneous catheter drainage as a primary treatment of patients with infected necrotizing pancreatitis[J].Experimental and Therapeutic Medicine,2017,34(5):90-92.
[3]沙俊峰,安建立,牛洪涛.经皮肝胆管穿刺引流术加胆管支架置入术治疗恶性梗阻性黄疸[J].川北医学院学报,2017,32(4):540-542.
[4]姜中华,管敬,范志宁,等.经皮肝穿刺置入胆管支架对胃癌术后复发致胆管梗阻的治疗价值[J].中国微创外科杂志,2015,15(5):410-413.
[5]咸蕾,薛苏阳,庄树武,等.胆道支架联合经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸的临床疗效[J].中国老年学杂志,2016,36(17):4250-4251.
[6]黄毅斌,端学军,胡萍香,等.超声导航辅助经皮穿刺胆管置管引流术治疗肝内胆管结石梗阻效果观察[J].中华实用诊断与治疗杂志,2016,30(3):287-289.
[7]胡文军,郑楠,潘君玲.超声引导与数字减影血管造影引导在经皮肝胆道镜治疗肝胆管结石术前建立通道的比较研究[J].中国医药导报,2016,37(13):109-112.
[8]Satoh T,Kikuyama M,Yokoi Y,et al.Dual drainage using a percutaneous pancreatic duct technique contributed to resolution of severe acute pancreatitis[J].Clinical Journal of Gastroenterology,2017,10(2):191-195.
[9]Thorsen A,Borch A M,Novovic S,et al.Endoscopic Necrosectomy Through Percutaneous Self-Expanding Metal Stents May Be a Promising Additive in Treatment of Necrotizing Pancreatitis[J].Digestive Diseases and Sciences,2018,28(5):45-47.
[10]闫卫锋,周信远,魏秋亚,等.内镜逆行胰胆管造影术与经皮肝穿刺胆道引流术治疗肝外胆管梗阻性黄疸的对比研究[J].中华临床医师杂志(电子版),2015,9(4):569-572.
[11]于德江,任为正,岳振宇,等.超声引导下经皮肝内胆管穿刺置管引流479例分析[J].中华肝胆外科杂志,2018,24(2):83-86.
[12]陈章彬,陈见中,滕毅山.经皮经肝穿刺胆道引流术在腹腔镜下胆道探查术后一期缝合中的应用价值[J].中国普通外科杂志,2018,27(2):156-162.
[13]史瑞,张厂,李旭彤,等.经皮经肝胆囊穿刺联合内镜治疗梗阻性黄疸一例[J].中华消化内镜杂志,2016,33(3):191-192.
[14]程黎娜,丁辉,杨惠,等.老年晚期恶性梗阻性黄疸3种姑息治疗方法的疗效比较[J].中国内镜杂志,2015,21(11):1148-1151.
[15]高兴强,毛建芳,念丁芳,等.经皮经肝胆管穿刺引流术联合二期胆总管取石治疗高龄胆总管结石[J].中国中西医结合影像学杂志,2017,15(1):97-99.
[16]翁高龙,黄建国.彩超引导经皮肝穿刺胆管置管引流术治疗恶性梗阻性黄疸[J].中国临床医学影像杂志,2014,25(1):55-57.
[17]姜兆鹏,周显礼,纪巧,等.超声引导下经皮经肝穿刺胆囊置管引流术治疗急性胆源性胰腺炎[J].中国介入影像与治疗学,2015,12(10):588-591.
[18]任贵军,王洋,曾强,等.超声引导下穿刺置管引流治疗亲体肝移植术后早期胆漏的临床分析[J].河北医药,2016,38(17):2675-2676.
[19]咸蕾,薛苏阳,庄树武,等.胆道支架联合经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸的临床疗效[J].中国老年学杂志,2016,36(17):4250-4251.
[20]彭观景,陈博艺,李称才,等.经皮肝穿刺胆道引流瘘道硬质胆镜取石治疗复发性胆石症[J].中国医学工程,2017,25(3):32-36.
[2]Cao X,Cao F,Li A,et al.Predictive factors of pancreatic necrosectomy following percutaneous catheter drainage as a primary treatment of patients with infected necrotizing pancreatitis[J].Experimental and Therapeutic Medicine,2017,34(5):90-92.
[3]沙俊峰,安建立,牛洪涛.经皮肝胆管穿刺引流术加胆管支架置入术治疗恶性梗阻性黄疸[J].川北医学院学报,2017,32(4):540-542.
[4]姜中华,管敬,范志宁,等.经皮肝穿刺置入胆管支架对胃癌术后复发致胆管梗阻的治疗价值[J].中国微创外科杂志,2015,15(5):410-413.
[5]咸蕾,薛苏阳,庄树武,等.胆道支架联合经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸的临床疗效[J].中国老年学杂志,2016,36(17):4250-4251.
[6]黄毅斌,端学军,胡萍香,等.超声导航辅助经皮穿刺胆管置管引流术治疗肝内胆管结石梗阻效果观察[J].中华实用诊断与治疗杂志,2016,30(3):287-289.
[7]胡文军,郑楠,潘君玲.超声引导与数字减影血管造影引导在经皮肝胆道镜治疗肝胆管结石术前建立通道的比较研究[J].中国医药导报,2016,37(13):109-112.
[8]Satoh T,Kikuyama M,Yokoi Y,et al.Dual drainage using a percutaneous pancreatic duct technique contributed to resolution of severe acute pancreatitis[J].Clinical Journal of Gastroenterology,2017,10(2):191-195.
[9]Thorsen A,Borch A M,Novovic S,et al.Endoscopic Necrosectomy Through Percutaneous Self-Expanding Metal Stents May Be a Promising Additive in Treatment of Necrotizing Pancreatitis[J].Digestive Diseases and Sciences,2018,28(5):45-47.
[10]闫卫锋,周信远,魏秋亚,等.内镜逆行胰胆管造影术与经皮肝穿刺胆道引流术治疗肝外胆管梗阻性黄疸的对比研究[J].中华临床医师杂志(电子版),2015,9(4):569-572.
[11]于德江,任为正,岳振宇,等.超声引导下经皮肝内胆管穿刺置管引流479例分析[J].中华肝胆外科杂志,2018,24(2):83-86.
[12]陈章彬,陈见中,滕毅山.经皮经肝穿刺胆道引流术在腹腔镜下胆道探查术后一期缝合中的应用价值[J].中国普通外科杂志,2018,27(2):156-162.
[13]史瑞,张厂,李旭彤,等.经皮经肝胆囊穿刺联合内镜治疗梗阻性黄疸一例[J].中华消化内镜杂志,2016,33(3):191-192.
[14]程黎娜,丁辉,杨惠,等.老年晚期恶性梗阻性黄疸3种姑息治疗方法的疗效比较[J].中国内镜杂志,2015,21(11):1148-1151.
[15]高兴强,毛建芳,念丁芳,等.经皮经肝胆管穿刺引流术联合二期胆总管取石治疗高龄胆总管结石[J].中国中西医结合影像学杂志,2017,15(1):97-99.
[16]翁高龙,黄建国.彩超引导经皮肝穿刺胆管置管引流术治疗恶性梗阻性黄疸[J].中国临床医学影像杂志,2014,25(1):55-57.
[17]姜兆鹏,周显礼,纪巧,等.超声引导下经皮经肝穿刺胆囊置管引流术治疗急性胆源性胰腺炎[J].中国介入影像与治疗学,2015,12(10):588-591.
[18]任贵军,王洋,曾强,等.超声引导下穿刺置管引流治疗亲体肝移植术后早期胆漏的临床分析[J].河北医药,2016,38(17):2675-2676.
[19]咸蕾,薛苏阳,庄树武,等.胆道支架联合经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸的临床疗效[J].中国老年学杂志,2016,36(17):4250-4251.
[20]彭观景,陈博艺,李称才,等.经皮肝穿刺胆道引流瘘道硬质胆镜取石治疗复发性胆石症[J].中国医学工程,2017,25(3):32-36.